Behavioral Health Program Changes Eff 01/2011: Updated FAQs
As announced, effective January 2011, BCBSTX will manage behavioral health services for all non-HMO members, replacing Magellan Health Services. We have updated the previously posted Frequently Asked Questions (FAQs) that review how the upcoming changes may affect you. View the updated FAQs .
Behavioral health care management will be further integrated with our Blue Care Connection® medical care management program. The goal of the integrated Behavioral Health program is to support early identification of members that could benefit from co-management of behavioral health and medical conditions. This service delivery model may result in improved outcomes, enhanced continuity of care, greater clinical efficiencies, and reduced costs over time.
BCBSTX will work with the member's current behavioral health professional or physician to help limit the possibility for disruptions in patient care coordination during this transition. You can use the same phone numbers on the back of the member ID card for requesting preauthorization, submitting continuity of care plans, contacting customer service inquiries and more.
Outpatient Preauthorization Requirement Updates
Members may receive authorization for up to 10 outpatient visits per plan year to any behavioral health professional(s) without the need to submit medical records/Outpatient Treatment Request (OTR) forms. However, the member, or the provider on the member's behalf, must request preauthorization from BCBSTX before an outpatient service/visit. All claims will be reviewed, and services must be deemed medically necessary as outlined in the member's benefit booklet.
All outpatient behavioral health visits scheduled after the first 10 visits will require that you submit an OTR form. You can call BCBSTX with the required information at any point before the 11th visit using the number on the back of the member's ID card.
Note: These outpatient preauthorization requirements will not be in effect until the member's 2011 group renewal.
We have updated the previously posted FAQs that review how the upcoming changes may affect you. View the updated FAQs .
For program implementation details, watch the online What's New section, and upcoming issues of Blue Review. If you have any questions, please contact your professional provider network representative.
All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan.